Claims Administrator Services

The New Jersey Counties Excess Joint Insurance Fund is seeking an experienced firm to provide comprehensive claims‑administration and managed‑care services for its excess liability, workers‑compensation, and select property programs covering ten (potentially more) member counties. The contractor will assume responsibility for handling excess‑layer claims, supervising member TPAs, setting reserves, issuing payments, maintaining detailed financial records, and delivering a suite of regular reports and data uploads to the Fund’s RMIS. Managed‑care duties include operating a 24/7 provider network, pre‑authorizing medical treatment, re‑pricing provider bills, and supporting early return‑to‑work initiatives. The contract runs for three years (Oct 1 2026 – Sep 30 2029) with a 60‑day proposal validity and includes extensive insurance and indemnity requirements. • Claims‑administration for excess‑layer liability and workers’ compensation, including reserve setting, payment issuance, and coordination with excess carriers. • Managed‑care services: 24/7 network maintenance, pre‑authorizations, bill re‑pricing, and quarterly utilization reporting. • Mandatory reporting: monthly claim registers, quarterly loss‑run reports, 90‑day updates, and data uploads to Origami Risk RMIS within defined timeframes. • Vendor must furnish comprehensive insurance coverage (Professional Liability $1 M, General Liability $1 M/$3 M, Employers’ Liability $500 k, Auto Liability $1 M) and certify compliance with New Jersey statutes and OFAC restrictions. • Proposals must be submitted in sealed hard‑copy envelopes (plus accompanying email) by 11:00 a.m. on Aug 11 2026; questions due by July 27 2026.